Wellness and Lifestyle Services

This form is intended for IV nutrition requests only.

For Medicinal Cannabinoids prescription requests, please click here

For non-Medicinal Cannabinoid prescriptions, please click here.

I am requesting a medical evaluation to receive intravenous nutrients to optimize my nutrient levels.

I understand and accept that it is safer to take oral nutrients than via an intravenous route.

 I understand and consent that my information including health information can be shared with government regulatory agencies(compliance) and other medical agencies (including Labtest) that are involved in my care.

I agree the exchange of my information (including health information) may be done via email ( non-encrypted).

In case of a Video and/or Audio Virtual Consultation I agree for this to be recorded.

I have read and understood the Health Information & Privacy Code as posted on AWC website.

I understand that some of the medicines suggested are dispensed under Section 29 of the Medicines Regulations 1984, and are considered as ‘unproven medicines’.

I declare that all information I have provided to AWC is true and correct.

Your information will be evaluated within the next 2 working days.

By proceeding to payment I understand and accept the T&C of this service as stated above.

AWC services is to evaluate the safety, appropriateness and eligibility of prescriptions to meet patient needs.

AWC will endeavour to reconcile your request with the information available online.

Failure to pay may result in your request not being completed.